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Hormone replacement therapy and venous thromboembolism.
Andrew Eisenberger1, Carolyn Westhoff2
1College of Physicians and Surgeons, Columbia University Medical Center, Division of Hematology/Oncology, 177 Fort Washington Avenue, MHB 6-435, New York, NY 10032, United States.
The Journal of Steroid Biochemistry and Molecular Biology
|September 7, 2013
Summary
Hormone replacement therapy (HRT) can increase the risk of venous thromboembolism (VTE) in post-menopausal women, particularly soon after starting treatment. The risk decreases after stopping HRT, and individual risk factors should be discussed.
Area of Science:
- Reproductive Endocrinology
- Thrombosis Research
- Menopause Medicine
Background:
- Hormone replacement therapy (HRT) is used for managing menopausal symptoms.
- HRT is associated with an increased risk of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism.
- The absolute VTE risk for individuals is generally low, but it is a significant consideration in HRT prescribing.
Purpose of the Study:
- To review the relationship between HRT and VTE risk in post-menopausal women.
- To discuss factors influencing VTE risk, administration routes, and potential genetic predispositions.
- To highlight the importance of individualized risk-benefit discussions for HRT users.
Main Methods:
- Review of existing literature and retrospective analyses on HRT and VTE.
- Examination of data regarding different HRT formulations (oral vs. transdermal, estrogen-only vs. combined).
- Consideration of patient-specific risk factors such as age, weight, and genetic factors like Factor V Leiden.
Main Results:
- VTE risk is highest early in HRT use and diminishes upon discontinuation.
- Transdermal HRT may have a lower VTE risk than oral HRT, though more research is needed.
- Age, weight, and genetic factors like Factor V Leiden can increase HRT-associated VTE risk.
Conclusions:
- While HRT carries a VTE risk, the absolute risk is small for most individuals.
- Current evidence does not support routine genetic screening for HRT candidates.
- Personalized medical consultation is crucial to weigh HRT benefits against VTE risks, as complete risk mitigation is not possible.
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